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Prevalence and outcome of comorbidities associated with acromegaly

  • Original Article - Pituitaries
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Abstract

Background

Acromegaly is associated with various comorbidities, such as arterial hypertension (aHT), type 2 diabetes mellitus (DM2), obstructive sleep apnoea syndrome (OSAS), carpal tunnel syndrome (CTS) and polyposis coli. For therapeutic decisions, it is essential to know if, and to what extent, these associated morbidities are reversible or preventable. The aim of this study is to assess the prevalence and course of aHT, obesity, OSAS, CTS, DM2 and polyposis coli in acromegalic patients.

Methods

The following criteria for inclusion in this database study were used: treatment for acromegaly at the authors’ institutions; full endocrinological and radiological work- and follow-up; screening for aHT, DM2, CTS, OSAS, obesity and polyposis coli. All patients were followed-up for > 3 months, and treatments were indicated with the intent of biochemical remission (normal IGF-1 and random growth hormone level).

Results

Sixty-three patients were included. Twelve (19%), 45 (71%) and 6 (10%) patients harboured micro-, macro- and giant adenomas, respectively. Nineteen tumours (30%) invaded the cavernous sinus. Mean tumour volume was 5.4 cm3. Mean follow-up time was 42 months. Sixty-one (97%) patients had transsphenoidal surgery; two patients only had drug therapy. Surgery led to remission in 31 (51%) patients. Intracavernous growth and larger tumour volume were negative predictors for cure. Drug therapy lead to remission in 22 (73%) patients within a mean follow-up of 54 months. The pretherapeutic prevalence of associated morbidities was as follows: aHT, 56%; DM2, 25%; OSAS, 29%; CTS, 29%; polyposis coli, 5%. There were neither age nor gender preferences for the respective prevalences. Surgery leads to remission of aHT and DM2 in 6% and 25%, respectively. Additional drug therapy resulted in remission of aHT, DM2 and CTS in 17%, 14% and 14%, respectively. Other associated morbidities persisted regardless of therapeutic efforts. Even if criteria for remission were not met, no new comorbidities of acromegaly developed during follow-up.

Conclusions

Treating acromegaly may relieve threatening associated morbidities such as aHT and DM2; nevertheless, only few comorbidities are reversible, which highlights the importance of treating acromegaly as early as possible.

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Funding

This study was funded by the research grant of the Kantonsspital Aarau AG, Aarau, Switzerland (Award Number: 1410.000.069).

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Author notes

  1. Sven Berkmann and Joël Brun contributed equally to this work.

Authors and Affiliations

  1. Department of Neurosurgery, Kantonsspital Aarau, 5001, Aarau, Switzerland

    Sven Berkmann & Joël Brun

  2. Division of Endocrinology, University Department of Medicine, Kantonsspital Aarau, Aarau, Switzerland

    Philipp Schuetz & Beat Mueller

  3. Division of Endocrinology, Diabteology and Metabolism, University Department of Medicine, Universitaetsspital Basel, Basel, Switzerland

    Emanuel Christ

  4. Department of Neurosurgery, Universitaetsspital Basel, Basel, Switzerland

    Luigi Mariani

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  1. Sven Berkmann
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  2. Joël Brun
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  4. Emanuel Christ
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  6. Beat Mueller
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Contributions

Conceptualization: Sven Berkmann, Joël Brun; Data curation: Sven Berkmann, Joël Brun; Methodology: Sven Berkmann, Joël Brun; Formal analysis and investigation: Sven Berkmann, Joël Brun; Writing — original draft preparation: Sven Berkmann, Joël Brun; Writing — review and editing: all authors; Funding acquisition: Sven Berkmann; Resources: Sven Berkmann; Supervision: Sven Berkmann.

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Correspondence to Sven Berkmann.

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Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. The study was approved by the local ethical committee (EKNZ 2015–375).

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Informed consent was obtained from all individual participants included in the study.

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Berkmann, S., Brun, J., Schuetz, P. et al. Prevalence and outcome of comorbidities associated with acromegaly. Acta Neurochir 163, 3171–3180 (2021). https://doi.org/10.1007/s00701-021-04846-8

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